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Book review: Advance care planning in end of life care

Author: Dr Ollie Minton
09 February 2018

Dr Ollie Minton (PhD FRCP) is a Macmillan consultant and honorary senior lecturer in palliative medicine based at St George's University Hospital Foundation NHS trust. Here he reviews the second edition of Advance care planning in end of life care for ehospice.

This is an update to a 2010 first edition and allows for an international comparison of advance care planning (ACP) and an update of the available evidence.

There is a foreword from the now ex-medical director of the NHS (Sir Bruce Keogh) highlighting the links to the importance of ACP in all clinical settings.

The editors rightly point out we are all going to die at some point and for a large proportion of us this is a predictable event. In a time of limited resources avoiding interventions and ‘just because we can doesn’t mean we should’ we need an evidence based approach to assessing trade-offs in someone approaching the end of their life.

The book stresses the importance of good communication and a personalised approach to assessing priorities in someone who is approaching the end of their life.

The book is 300 pages and divided into 27 brief chapters covering the relevant aspects in considerable detail. There are four sections – an introduction to advance care planning, context and experience, international experience and finally practicalities.

I think this update is necessary to cut through the complexity of the available models, approaches, evidence and the legal aspects. These include helpful chapters on resuscitation conversations and dealing with uncertainty.

There is much to recommend but the book is definitely for specialists – the length and detail make it a useful update but I would have liked some focus to guide generalists about when and how to have these conversations.

I am left with a sense of some duplication of effort at times and a lack of a clear practical method to achieve the aims of ACP. This is perhaps not surprising and what it lacks in specific guidance is more than made up for in the referencing and evidence which people can explore in detail from the various chapters.

This is a serious attempt to cover the importance aspects of ACP and its impact on both palliative care clinicians and beyond. The last section on the practicalities and areas of common ground are most broadly relevant to all.

A summary of the key messages would be very helpful or at the very least some links for the wider audience who will not get to read the content in depth.

We all need to be able to plan ahead and make our wishes clear – this updated book is an excellent summary of the available evidence – now is the time to translate this into practice.

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